Moka is helping to reduce high mortality rates from preventable illnesses such as malaria, measles and pneumonia by addressing key breakdowns in the drug supply chain that, if resolved, could supply and distribute life-saving medication to those in need.
The New Idea
Moka has developed a solution to radically enhance the efficiency of healthcare delivery in Kenya’s public health system by automating the supply chain of free and/or publicly subsidized essential drugs to rural health clinics. Through his innovation, ZiDi, Moka is ensuring that rural households are able to access high quality treatment in a reliable, affordable and timely way. He envisions that with guaranteed access to affordable medication patients will not turn to the expensive private health service providers or, even worse, the black market for lifesaving drugs as they currently do.
Moka’s idea was born from the insight that access to reliable, timely and affordable lifesaving drugs constitutes a critical “last-mile” in the healthcare delivery system, one which is largely missing for the majority of rural-based households that depend on public hospitals for these drugs. Without proper inventory management systems that are integrated with the existing workflows of healthcare providers, public health clinics cannot ensure that subsidized medication reaches those most in need.
With this in mind, Moka’s team developed ZiDi as a tablet-based application software for managing data from each patient encounter as recorded by healthcare providers at the point of service. Nurses and/or doctors enter patient data and details of each encounter onto ZiDi before uploading it for cloud storage. This data is immediately available for subsequent encounters and makes it possible to track the inventory for drugs at the clinic. A detailed report of projected inventory needs is generated instantaneously and made available to the national drugs supply agency, KEMSA (Kenya Medical Supplies Agency). This ensures that KEMSA-supplied essential drugs only exit the supply chain through a proper diagnosis and prescription at the point of care.
Although the tracking of pharmacuetical inventories is a key outcome, ZiDi is an integrated platform capable of capturing information on all outpatient lines of service including child welfare clinics and immunization services, family planning, antenatal care, maternity services, postnatal care and HIV and Tuberculosis care. A gender-based violence module is currently being added to the workflows as well. In this way, health workers are not asked to merely provide data to assist in commodity tracking but are also able to generate service utilization reports and financial and human resource reports across different care delivery lines. Consequently, ZiDi’s applicability to different healthcare delivery lines ensures that it will be more widely used across the healthcare sector and that it will provide a more accurate and comprehensive picture of citizens’ health and the public health care system. This is a first for Kenya after numerous failed attempts over the years.
In addition to ZiDi, Moka has launched 2020 Microclinic Initiatives, a non-profit organization that is trains and employs over 5,000 youths to work as “Blue Angels” that provide technical support and maintenance for ZiDi tablets and supplementary solar energy and internet connectivity systems. As most rural clinics lack connection to mains power grid and reliable internet connectivity, Moka’s solution includes reliable solar power and internet connectivity. In order for these systems to work seamlessly, they will require trained personell to install, maintain, diagnose and troubleshoot whenever a problem occurs. Moka believes that this role cannot be left to nurses and practitioners as this is where similar initiatives to digitize and track healthcare services in the past have failed. Therefore, he has created an entirely new role within the public healthcare system that will be a major source of employment for young people. Moka realizes that these Blue Angels will be empowered to either start their own entrprises or seek employment in the private sector but considers this to be complementary to his overall vision of a complete transformation for the entire healthcare system. In this way, Moka is not only transforming the healthcare system in Kenya but also increasing the employment opportunities for, and the employability of, newly trained young Kenyans in this sector.
Kenya’s public healthcare system suffers from a broken supply chain for subsidized essential drugs. This leads to high mortality rates from treatable illnesses and the prevalence of counterfeit drugs, especially in rural areas. The shortage of essential drugs for treating the top five causes for infant mortality - malaria, pneumonia, food and water borne diseases and measles – is a common occurence in rural public health facilities. Moka explains that as soon as basic drugs that are regularly perscribed in government hospitals are in short supply, a doctor or nurse is forced to write a perscription. When this happens, the best case scenario is that the same nurse smuggles legitimate drugs out of the hospital and sells them on the black market for a far higher price. A more likely scenario, however, is that expensive counterfeit drugs are brought in and illicit pharamacies open up to meet this demand. Irregular and unpredictable supplies of essential drugs must be avoided, not just for the obvious impact on patients in need, but also on account of the fact that this key breakage in the supply chain can help create the counterfeit drug industry.
Recent studies have estimated that up to 40 percent of drugs in the open market “lack an active ingredient or contain a toxic compound,” meaning that they are counterfeit. Moka knows this problem all too well as a trained toxicologist and victim of counterfeit malarial drug that he purchased from a major hospital in Cameroon. He developed an allergic reaction that caused him to be admited to hospital for three days.
Moka identified gaps in previous attempts to streamline the health care management system during the pilot phase of his work. He recalls in one instance where the Minister of Health lamented that even after 50 years of independence, Kenya was unable to quantify how much malaria medicince is consumed or needed in the country. The Kenya Medical Supplies Agency was established in 2004 to address massive discrepancies in the drug supply chain which resulted in some clinics being overstocked while others were severely understocked. Unfortunately, KEMSA introduced a manual tracking system that added delays to the supply chain and instituted parallel supply lines for each of the five major diseases. The breakdown in the supply chain of drugs to public healthcare facilities is linked to the inefficient way in which these drugs are tracked and ordered. In most health clinics, nurses are required to manually track drug consumption and make demand forecasts for up to 90 days in advance. A single compilation to order a new supply requires up to 1,400 calculations. This overburdens healthcare workers with administrative tasks and thus, reduces their efficiency in providing actual care to patients. Preliminary studies indicate that 75 percent of rural clinics in Western Kenya are performing below capacity or close to shutting down. For example, Kasongo Dispensary (located in Western Kenya and one of the pilot sites for 2020 MicroClinic Initiatives) has, on average, only 23 percent of the 103 essential drugs that the facility should have from the Kenya Medical Supply Authority (KEMSA) in stock. Furthermore, 40 percent of the drugs they should have are overstocked and 10 percent are set to run out within 10 days. Unfortunately, most clinics face similar irregularities and shortages in drug supplies and thus, are unable to provide medication to those patients in need. In the most recent attempt to remedy this problem, the Ministry of Health trained healthworkers nationalwide to use the Essential Medicines and Medical Supplies Order Form that requires 1440 calculations to fill. As a result, less than 25% of health facilities place their orders on time, some don’t apply at all. Coming to a situation with such a difficult background of failed attempts, Moka was able to tailor an all rounded solution that brings together all the major partners that will ensure his idea gets adopted and spread across the entire country.
Moka realizes that a complete transformation of the public healthcare system will require more than just a properly funcitioning and efficient supply chain for publicly subsidized drugs. He is especially attuned to the siloed nature in which healthcare services are delivered as a result of the siloed nature of public healthcare funding both locally and internationally. For example, there are separate national agencies that deal with HIV/AIDs, Malaria and water borne diseases, TB and Family Planning. This is especially disadvantageous for rural health clincis which lack the human resources to run separate service lines. As a consequence, nurses are overburdened with administrative tasks of generating service delivery reports not to mention other management related reports such as financial accounts and inventories.
The problem of inadequate capacity in public healthcare system is quite prevalent. Kenya is a net exporter of nurses and other health practitioners to developed countries, mainly the UK, due to poor remuneration and working conditions. For Moka, such lack of capacity calls for increased efficiency by the few practitioners who are available. Even where a solution like ZiDi promises to improve the performance of nurses, they cannot be expected to manage the technical aspects of the ZiDi tablets and the accompanying solar and internet systems. This partly explains the numerous failed attempts to revamp the healthcare system in Kenya which largely ignored the problem of inadequate human resource capacity.
Moka’s strategy is driven by the objective to reach as many people as possible. He decided quite early on that his solution should be integrated with the national public health system, which reaches a majority of his target rural and peri-urban population. Although private health clinics in the country would use his solution, they only serve a subsection of the population that can afford to pay premium fees. In addition, they do not supply the publicly subsidized essential drugs that are the core focus of Moka’s initial work. Therefore, after a successful one and a half year pilot in western Kenya, he has established a partnership with the Ministry of Health and the Kenya Medical Supplies Agency to roll out his program in 5000 public health clinics across the entire country.
Moka was able to onboard key partners onboard for his initiative primarily because his solution enhances the allocation of critical resources (inventories, human and financial capital) in the health care sector, based on need and prevents unnecssary breakdowns and irregularities in the supply chain. Unlike the old system, ZiDi eliminates the administrative burden on health workers as well as the risk of errors associated with manual tracking of patient data and services delivered. It also adjusts the demand forecasts based on seasonal and geographical patterns of disease incidences, allowing the government to efficiently identify gaps in the variety and quanity of drugs procured.
As part of his scaling strategy, Moka has partnered with community level organizations, such as the Ogra Foundation in Kisumu, in order to provide ongoing supervision and support that is commensurate with the scale and rapid roll-out plan for the rest of the country and continent. To ensure that the system operates at 90 percent optimal levels and that nurses and health workers are not charged with the additional responsibilities of maintaining the system, 2020 Microclinic is training and employing over 5,000 youths to provide technical support in health clinics. This essentially creates new roles within the healthcare sector that will also aid in the adoption of future technologies at the grassroots level. Moka is establishing partnerships with vocational and technical colleges to offer short courses in this specific IT technology. He is aware that the young people who are trained and employed through his program will likely get poached into the private sector but believes that this is consistent with his overall mission of empowering marginalized groups through his initiative.
After piloting ZiDi in 3 rural clinics in Kisumu County, Moka has aquired the authorization of Kenya’s Ministry of Health to implement ZiDi in 5,000 clinics across the entire country.
His goal is to reach at least 75 percent of the market within the next two years. 2020 Microclinic has already received the go ahead from the Ministry of Health to begin the rollout of the program across the country. Moka plans to scale to other African countries once ZiDi is fully integrated into the Kenyan healthcare system. To this goal, he has entered into partnership with Microsoft 4Africa, which currently funds 3 employees of his core team of developers.
Moka comes from a very entrepreneurial Cameroonian family. As the country’s first public health expert, Moka’s father championed the use of iodine to eliminate goitre, hypothyroidsm and cretinism conditions. His mother was a nationally known educator and feminist known who promoted gender equity and women’s empowerment. She was an early believer and advocate for girl child education in Cameroon and is the founder of a 400-student primary and secondary school. Moka acknowledges that growing up a witness to his parents civic engagement and social activism created an indelible desire in him to become a social change agent. From them he learned the value of sacrifice in changemaking and that solutions to most social issues do exist but that reward does come at a risk.
At age nine, Moka was sent to boarding school and he attributes his sense of collective responsibility to this experience. He also became aware of and increasingly attentive to issues of inequity. The missionary-led school demanded personal excellence and teamwork in equal measure. Moka and his classmates learned to influence and protect one another to avoid having any classmate drop out. He recalls giving up a new pair of shoes to another child who walked barefoot. He would also split his pencils in half to share with a classmate who didn’t have anything to write with. In high school, he mobilized students to demand a change in the school diet. These experiences set Moka off on a path of changemaking that continues to date.
After finishing high school, Moka was eager to pursue a career in medicine, this being the most clear way he could think of to give back to society. While at medical school in Cameroon, Moka also began to understand his own changemaker potential. Early on he founded an association of English-speaking students to promote collaboration with medical students in English-speaking countries. This was in response to the fact that French is the dominant language in Cameroon yet the country has a sizeable English-speaking population. Then in 1998, Moka was a founding member and second president of the African Society for Toxicological Sciences, which promotes safe use of drugs and chemicals in Africa. While pursuing his graduate studies at the University of Uppsalla under the mentorship of the now renowned Professor Hans Rosling, Moka was part of a team of scientists who discovered the first cases of Konzo disease in Africa.
Moka moved to the University of Rochester in New York to pursue a doctorate degree in toxicology, where again he used his entrepreneural skills to launch The Baobab Culture Center. This was the first African cultural center in Rochester and the surrounding region that has a significant African migrant population. The center continues to date and has attracted the support of the New York State Council on the Arts and Humanities.
While working for a health care insurance company in upstate New York, Moka launched an initiative to increase the enrollment of urban poor minorities into Medicaid. Challenges such as complicated paperwork had prevented them from enrolling and he created a new tool that made the application more intuitive. The company rejected his proposal and he resigned soon after.
Although he didn’t have plan for his next step, Moka knew that he needed to channel his talents, skills and experience towards a social impact mission back on his home continent. He enrolled in a Public Health executive program at Harvard, where he found the time to reflect on his experiences in medicine, community mobilization, toxology, data management, and access to healthcare and began to form the idea behind 2020 Microclinic Initiative. He has since moved to focus fulltime on this work.